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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is for women who are having, or are about to have, radiotherapy to the pelvic area (lower part of the abdomen). Radiotherapy| to the pelvis can cause side effects. This information is about the possible side effects and how they can be controlled if they occur.
The pelvic area is the lower part of the abdomen (lower tummy). It contains organs that make up a woman's reproductive system, which are the parts of the body involved in having sex, carrying a baby and giving birth. The bladder and the bowel are also contained in the pelvic area.
A woman's reproductive system includes parts of the body such as the womb, the ovaries, the cervix and vagina.
The female reproductive system
View a large copy of the image of the female reproductive system|
The pelvic area also includes the lower end of the large bowel (colon, rectum and anus) and part of the small bowel called the ileum. There are also some lymph nodes, also known as lymph glands.
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells while doing as little harm as possible to normal cells. Radiotherapy can be given to the pelvic area to treat many different types of cancer.
In women, it is mainly used to treat cancer of the vulva|, vagina|, cervix| and womb|, but may also be used to treat cancer of the bladder|, rectum| and anus|. Radiotherapy may sometimes be given to the lymph nodes in the pelvic area
The digestive system
View a large version of the illustration of the digestive system|
Radiotherapy can either be given externally from outside the body or internally from within the body. Some women may have a combination of the two.
External radiotherapy| is normally given as a series of short daily treatments in the radiotherapy department at the hospital, using equipment similar to a large x-ray machine. Treatment is often given over several weeks, once a day Monday-Friday, with a rest at the weekends. Each treatment takes several minutes and is painless. It will not make you radioactive and it is safe for you to be around other people, including children. You may be able to have your treatment as an outpatient, or you may need to stay in the hospital.
Internal radiotherapy| is also known as intracavitary radiotherapy or brachytherapy|. It is sometimes used to treat cancer of the vagina, cervix or womb.
Hollow plastic or metal tubes (applicators) are inserted into the vagina. A machine feeds small radioactive metal balls (the source) into the tubes. The tubes are usually put in position under a general anaesthetic, but for some treatments an epidural anaesthetic or light sedation may be used.
Depending on the type of cancer, the treatment may take a few minutes to several days. Once the radiotherapy treatment has finished, the applicator tubes are removed by a doctor or nurse.
Internal radiotherapy gives a high dose of radiation to the area close to the applicator, but only a low dose to areas more than a few centimetres away. You will need to stay in bed during the treatment. You may need to have a tube put into your bladder (urinary catheter) to drain away any urine. The catheter can be uncomfortable and you may need to take painkillers.
The source gives off radioactivity that may be harmful to other people, so you will usually be nursed in a separate room, apart from the ward. Visitors may only be allowed to stay for a short time, during which the machine is switched off and the radioactive sources go back into the machine. Children and pregnant women are advised not to visit. Once the applicators have been removed, it is completely safe for you to be around other people.
Some women find that this treatment can make them feel isolated and depressed. It is important to let the staff looking after you know how you feel. It can also help to have plenty of things to keep you occupied, such as books to read, for the day or two that you are having treatment.
These days, an implant containing a higher dose of radioactivity is often used and this is only in place for a few minutes. These shorter treatments may need to be repeated several times, a few days apart, and may be given as an inpatient or outpatient. This treatment doesn't need a tube (catheter) in the bladder to drain the urine, but a catheter may be needed when x-ray pictures are taken during the planning of the treatment.
Internal radiotherapy may be uncomfortable and the staff will make sure that you are made comfortable and given painkillers if you need them, especially before the source is removed.
While radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. You should be given the opportunity to discuss any possible side effects with your doctor or radiographer. As there is often a lot of information to absorb it may help to take a relative or friend with you when you see the doctor. You can also ask your doctor to write down important points or to tape-record the conversation for you.
Radiotherapy affects people in different ways so it is difficult to predict exactly how you will react to your treatment. Most side effects will be temporary. It is fairly common for the short-term side effects to get worse for a couple of weeks after the treatment, before they get better. They then usually improve gradually over a few weeks.
Sometimes tiredness can be minimised by carefully planning your day, getting help with jobs in the house and making sure you sleep well. It's important to take time to allow yourself to recover after treatment and not try to do too much. However, if you are able to do some gentle exercise, this can help you feel less tired. It may be the last thing you feel like doing but sometimes, the less you do, the less you feel like doing. Just a short walk everyday can help. You can try to gradually increase the distance each time. Your doctor or nurse can give you more information about exercise, and we also have information about exercise after cancer treatment.
Radiotherapy can cause a skin reaction and you may find that your skin gets very sore. This is more likely to be a problem in the skin folds of the groins and the cleft of the buttocks. In some situations the skin may become broken.
It is important to keep the area of the body that is being treated clean. Wash it with lukewarm water only and use unperfumed soaps. The area should be patted dry with a clean towel. Talcum powder and other scented products should not be used as they can irritate the skin. It is helpful to wear loose clothing to prevent any friction on the skin.
Your radiotherapy department will advise you how to look after your skin during treatment and the doctor can prescribe a cream, such as an aqueous cream, to ease any soreness. Always check with the radiotherapy department staff before using any creams on your skin.
Radiotherapy will make the hair fall out| in the area being treated. Other body hair is not affected. The hair should begin to grow back again within a few weeks of the treatment finishing but hair loss can be permanent for some people.
Radiotherapy can cause inflammation of the lining of the bladder. You may find that you have some of the following side effects:
It's usually possible to reduce or control these effects.
Let your doctor know if you have any problems passing urine. They may give you a urine test to make sure you haven’t got an infection. Medicines such as anti-inflammatory drugs, antibiotics and painkillers can be prescribed if needed.
The following may help:
This is in tea, coffee, cola, and some painkillers. Caffeine stimulates the nerves of the bladder.
Alcohol may make symptoms worse for some people.
You may be tempted to drink less so your bladder does not fill up so quickly. However, this can make symptoms worse as the urine becomes more concentrated and irritates the bladder lining. Aim to drink normal amounts of fluids each day. This is usually about two litres of liquid a day - about 6-8 cups of fluid.
Some women may find that they have mild incontinence for a few months after the treatment. It may be possible to deal with this by using incontinence pads which you can get from the radiotherapy department or your chemist. You can get advice about coping with incontinence from a specialist nurse or a continence advisor at the hospital.
If you are having difficulty passing urine, let your doctor or nurse know.
If you want to go to the toilet more often, or feel that you can’t wait when you do want to go, you can get a card to show to staff in shops, pubs and other places. The card allows you to use their toilets without them asking awkward questions. You can get the card from The Bladder and Bowel Foundation|.
If the radiotherapy area includes the small bowel (ileum), this may cause inflammation and irritation of the bowel. This may cause watery diarrhoea| and cramping pains in your abdomen (belly). If you already had diarrhoea, it can make the problem worse. Your doctor or radiotherapist can give you advice and may prescribe anti-diarrhoea medicines, such as Imodium® to help control it. Drugs to reduce spasms or cramps (antispasmodics or muscle relaxants) can also be prescribed.
It is helpful to drink plenty of fluids to replace those lost through diarrhoea. A dietitian can give you advice about your diet, although there is currently no evidence that changing your diet during pelvic radiotherapy, for example, taking less fibre, can prevent diarrhoea.
As well as diarrhoea, radiotherapy to the bowel may cause the following problems:
These symptoms should begin to improve once the radiotherapy has finished. It may take a few months for the bowel to settle down, although most women will have a permanent change to their bowel habit, which is usually mild. Let your doctor or nurse know about any symptoms you have, especially if you are passing blood. They may be able to help relieve the symptoms for you.
Pelvic radiotherapy usually stops the production of sex hormones by the ovaries. Hormone levels generally start to lower over about three months from the start of treatment. Your periods will gradually stop and the symptoms of the menopause may then occur. Your doctor or specialist nurse can talk to you about the effects radiotherapy is likely to have on you.
In some women it's possible to surgically move the ovaries out of the radiotherapy area before the treatment starts to avoid an early menopause.
An early menopause that's due to radiotherapy can cause more severe menopausal symptoms than a natural menopause. The symptoms will pass but they may take a couple of years. Symptoms can include:
These symptoms can affect your sex life|.
If you have an early menopause and are no longer producing eggs, you will not be able to become pregnant. It usually takes about three months after the radiotherapy finishes to stop producing eggs. During this time it is important to use effective contraception, but after this time contraception is not needed.
You can discuss with your specialist whether you can have hormone replacement therapy (HRT). This can help control menopausal symptoms.
If you've had breast cancer or some gynaecological cancers you may need to avoid taking HRT, which contains oestrogen. However, you can talk to your doctor about other medicines that can help control menopausal symptoms. Some post-menopausal women also have hot flushes after radiotherapy.
Having low sex hormone levels at a young age can increase the risk of weakening of the bones (osteoporosis) as women get older. HRT and other medicines can help the bones to stay healthy. Some women find complementary therapies such as evening primrose oil, acupuncture or herbal remedies helpful.
After pelvic radiotherapy you will not be able to have children. This is because of the effect that radiotherapy has on the womb. It can feel devastating to know that you will not be able to have children.
Infertility| is very hard to come to terms with, especially if you were planning to have children or to have more children. The sense of loss can be very painful and distressing. Sometimes it can feel as though you've actually lost a part of yourself.
Before treatment starts some women may want to see a fertility specialist to discuss the possibility of storing eggs or embryos (fertilised eggs). Any future fertility treatment will involve surrogacy (when a woman carries a pregnancy for another woman). Your doctor can usually refer you to a fertility specialist.
People vary in their reactions to infertility. Some women may come to terms with it more quickly and feel that dealing with the cancer is more important. Others may find that they accept the news calmly when they start treatment, but the impact doesn't hit them until the treatment is over. There's no right or wrong way to react.
It can help to include your partner in any discussions about fertility and future plans. You may both find it helpful to talk to a professional counsellor or therapist specialising in fertility problems.
Our cancer support specialists| can also help you find a counsellor for further help and advice.
For many women, most of the side effects will be temporary (short-term) and will disappear over a few weeks or months once the treatment has ended. For some women, one or two of the side effects may never go away after treatment and may become long-term problems.
Sometimes, side effects that start during radiotherapy get better after the treatment finishes, but then problems may start to occur many months or even years later.
It's very important to let your cancer specialist know if the side effects of your radiotherapy haven't improved a few weeks after the treatment has ended. It's also important to let them know if you get new side effects, or if any side effects get worse after the treatment. There may be a lot of things that can help you.
Some people get long-term bladder or bowel problems after pelvic radiotherapy. Other possible effects are damage to the bones or lymphoedema (swelling of the legs because of narrowing or blockage of the lymph drainage channels).
Radiotherapy can make the vaginal walls less stretchy, which can lead to difficulty with sexual activity or medical examinations. To maintain the health of the vaginal walls, your doctor, nurse or radiotherapist will advise you how to use vaginal dilators from about 2-8 weeks after the radiotherapy has ended.
All these effects are discussed in more detail in our information about the long-term effects of pelvic radiotherapy.
Most women will have some change in the way that their bladder or bowel works, and some may have vaginal changes and changes in the physical and emotional feelings associated with sex. The impact of these side effects varies from person to person.
Much can be done to help if this happens. Your cancer specialist or GP may be able to help you. They can also refer you to a doctor who has a special interest in treating long-term side effects of radiotherapy. These doctors are not in every hospital, so you may need to travel to see one.
The effects of pelvic radiotherapy may be difficult to talk about|. It can be embarrassing to say that you have problems with your bowel, bladder or sex life. However, doctors and specialist nurses are used to discussing intimate problems. You can tell them exactly what is happening to you. They will then be in the best position to help.
Your doctor or nurse can also refer you to a continence adviser or relationship and sexual therapist, if needed. The Bladder & Bowel Foundation can give you information and support on bladder and bowel problems.
The Bladder and Bowel Foundation |provide support and information for people affected by bowel and bladder problems. Has a ‘Just Can’t Wait’ card to allow holders access to toilets in shops and pubs.
COSRT| provides information on sexual problems. Lists of therapists are available to the public on their website or from the information department.
Crohn's and Colitis UK| is a national organisation for people with inflammatory bowel disease. Has information on coping with diarrhoea.
The Sexual Advice Association| provides information and leaflets about sexual difficulties. Has leaflets on all the medicines and pumps used for erectile dysfunction and impotence.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.